Enhancing rehabilitation services and quality of life for Aboriginal Australians after brain injury: Healing Right Way

The intervention consists of two components: i) Cultural Security Training for hospital staff surrounding brain injury, including culturally appropriate educational and treatment resources, The 3 hour face to face education session(s) will be delivered in a workshop format and will be predominately interactive and experiential. These sessions will consist of the sharing and discussion of information regarding the hospital’s local Aboriginal community and protocols, will address unique issues related to the experience of brain injury by Aboriginal people, and will explore authentic clinical situations and strategies to promote culturally secure brain injury care. The workshop will include information sharing; small and large group discussion, video case studies and activities to promote reflective practice. Creating a dialogue between non-Aboriginal health professionals and Aboriginal staff will be a key component of the training in order to model communication and problem solving from a ‘two-way’ perspective. Some content will vary across sites in order to align with local history, customs, language, and relevant cultural practices. The option of delivering the face to face component of the study's cultural security training to participating staff via online platforms has been added to accommodate this possibility under potential general health recommendations during the global pandemic. This component of the training remains group-based. The three online modules will constitute approximately 3 hours of study and also contain case study material related to Aboriginal brain injury survivors and their family. Participating staff will undertake short quizzes and write personal reflections related to the case studies. They will be provided with relevant readings regarding cultural security in hospital settings in particular and links to relevant websites. The three hour face to face training element of the cultural security training will be co-facilitated by a local Aboriginal cultural security trainer and a member of the research team. It will be undertaken with 20 staff at each of the study hospital sites. Relevant staff from neurology and neurosurgery/trauma/rehabilitation wards in metropolitan hospitals and general wards in regional hospitals will be nominated by discipline and service heads. A cross section of disciplines (including nursing, medical, and allied health staff) and levels of seniority is required at each site. The training will occur at least once at each site and will be offered every 6 months thereafter to address the issue of changing/rotating staff. Staff will be encouraged to disseminate knowledge gained through the training, and distribute resources as appropriate. The training will be delivered over a maximum period of three weeks at each site. The training will be undertaken to suit the individual site with alternative deliveries being one three hour block or 3 x 1 hour sessions. The face to face sessions must be completed before beginning the online modules. The online component must be completed within 3-4 weeks of completion of the face to face component. The online modules will be accessed through a secure site based at Edith Cowan University. Staff will log in to the training, and record their name, date of module engagement, and completion of each module. The face to face training will be group-based. The online training is undertaken individually. ii) The introduction of an Aboriginal Brain Injury Coordinator (ABIC) at each site. The ABIC will see the participants in hospital and up till 26 weeks post injury, providing education, support, liaison, and advocacy services to the participants and their families. The ABIC"s role includes: - Together with hospital staff, supporting the participant/family/carer to source correct information and guidance to make informed decisions which will impact on their access to rehabilitation services and overall wellbeing. - Providing up to date information, education, support and advocacy to the participants and their carers in the areas of brain injury and rehabilitation. - Ensuring all activities are aimed at enhancing access to rehabilitation services and promotion of participant wellbeing. - Facilitating communication between the participant and the hospital team regarding discharge plans and plans for medical and allied health follow-up after discharge. This will be done in collaboration with the medical and allied health teams. - Facilitating access to rehabilitation services and aiming to improve the health and wellbeing of participants by collaborating with general practitioners, Aboriginal Medical Services, specialists, hospital services, allied health professionals, support agencies and the Neurological Council of Western Australia (Inc.) (NCWA) as well as any other relevant support agencies as appropriate. - Becoming a clear link between agencies and the participants. - Monitoring the support needs of the participants following discharge from hospital, including as necessary, referrals and follow up with relevant organisations, endeavouring always to provide continuity of care. The ABIC will visit each participant within five working days of the completion of the baseline assessment and the visits will continue on a regular basis for 26 weeks post stroke/TBI. The ABIC will be in contact with the participant and/or a member of their family/carer a minimum of six times across this period, with contact made at least once every four weeks. There is no maximum number of contacts between the ABIC and the participant, with the ABIC providing services in line with variable health and support needs and time available. If it is not possible to visit the person within their home the ABIC will maintain contact with the participant through regular phone calls or video-teleconference facilities. Contacts will be approximately 30 minutes in duration. An Aboriginal person will be employed for one day/week at each of the project sites as an Aboriginal Brain Injury Coordinator (ABIC). The ABIC will see the participants in hospital and up till 26 weeks post injury onset and provide education, support, liaison, and advocacy services to the participants and their families. A minimum qualification of a Certificate 3 in a relevant health or community care subject of study will be required. Qualifications and experiences as an Enrolled or Registered Nurse or in Aboriginal Health Work will be highly desirable. The ABIC will receive 12 hours of training from the Neurological Council of Western Australia (NCWA) (a key project partner) and the research team. Each ABIC will be located either in the hospital, the local community controlled Aboriginal Medical Service (AMS), or offices of the NCWA as part of their community neurological nursing service, depending on the preference of each site. This person will be supported by the local AMS, the NCWA community nursing service, and the research project manager. The original online modules are not offered through the Indigenous HealthInfoNet as originally planned, but are still administered by Edith Cowan University.